Revolving Credit Application

General Information

Amount Requested*

Home Store*

Business Information

Name of Business*

In Business Since*

Federal ID Number(or SSN)*

Doing business as/also known as

Operate from home?*

SIC Code*

Business Gross Sales*

Business Fiscal Year*

Previous McCoy's Customer?*

Business Type*

Account Number

Business Address(No P.O. Boxes)

Address*

City(no abbreviations)*

State*

Zip*

Phone*

Cell

Fax

E-mail*

Mailing Address(If different than Business Address)

Address

City(no abbreviations)

State

Zip

Contact Information

First Name*

Last Name*

Position*

Phone*

Fax

E-mail

Authorized Buyers

First Name*

Last Name*

First Name

Last Name

First Name

Last Name

Trade References

Firm Name

Account Number

Firm Address

City

State

Zip

Phone Number

Fax Number

Firm Name

Account Number

Firm Address

City

State

Zip

Phone Number

Fax Number

Firm Name

Account Number

Firm Address

City

State

Zip

Phone Number

Fax Number

Bank Reference

Bank Name

Account Type

Phone

City(no abbreviations)

State

Zip

Guarantor

Principal Information/Personal Guarantor(If different than Business Address)

First Name*

Last Name*

Title

Date of Birth

Social Security Number*

Driver's License Number*

Street Address*

City (no abbreviations)*

State*

Zip*

Complete Company Legal Name

Guaranty Signature*

By clicking here, I am acknowledging that I have read the Guaranty. My typed initials, indicated beside this checkbox, serve as my signature to this effect.*

Submit

Account Agreement Signature*

By clicking here, I am acknowledging that I have read the Account Agreement. My typed initials, indicated beside this checkbox, serve as my signature to this effect.*

McCoy's Building Supply

Revolving Credit Application

General Information

Business Information

Business Address(No P.O. Boxes)

Mailing Address(If different than Business Address)

Contact Information

Authorized Buyers

Trade References

Bank Reference

Guarantor

Principal Information/Personal Guarantor(If different than Business Address)

Submit